The Johns Hopkins Institute for Clinical and Translational Research (ICTR) has been a productive, innovative and impactful organization in transforming how clinical and translational research is conducted throughout Johns Hopkins University. Enhancing collaborative research teams, advancing informatics, promoting new methodologies, providing access to regulatory support, and bringing researchers and the community closer together as true partners in discovery have all made translational research more successful. Over the next five years, the Johns Hopkins ICTR will move beyond its current research community to create a comprehensive regional hub that includes new partners ? the University of Maryland Baltimore (UMB), Morgan State University (MSU) and Kaiser Permanente Mid-Atlantic States (KPMAS). These partners bring complementary expertise and connections to distinct populations. Together, we have an opportunity to conduct high quality innovative research, and rapidly implement findings that impact the health of our state and region. Building on our extensive connections with community groups, we will move to a new phase of joint governance with bidirectional communication and participation on key ICTR committees. New programs will include a Trial Innovation Unit that will focus on improving methodologic and operational support for research teams conducting randomized clinical trials so that the impact of these trials is enhanced. A goal of this Unit will be to pilot and disseminate approaches that move randomized clinical trials closer to the precision medicine paradigm, with a focus on outcomes of greatest value to individual patients. Combining drug discovery scientists at Johns Hopkins with experts at the UMB School of Pharmacy, the ICTR will create a new Drug Discovery and Development Core. KPMAS and Johns Hopkins will continue to jointly fund programs that push the boundaries of how a Learning Health Care system can improve health outcomes. The ICTR provides a model for training investigators to work in multidisciplinary teams with experienced mentors using the most rigorous methodologies. We will enhance our training programs by incorporating principles of biodesign from the engineering tradition into the experience of all trainees. This places a higher emphasis on identification of the problem, engaging important stakeholders (clinicians, patients, IT professionals) to develop solutions, and identifying the most effective pathways to dissemination. Translational research demands the skills of many professionals working together to address complex problems. The Johns Hopkins ICTR is poised to leverage our current services to benefit new partners who have extensive responsibility for the conduct of research and health care delivery in Maryland. Working together, we expect to have a measurable impact on translational research in Maryland.